The Addiction.com Debate: Does Legalizing Marijuana Lead to More Addiction?

Anyone following the legalization and decriminalization of marijuana knows that public opinion has been shifting a lot over the years. As of early 2015, 27 U.S. states and the District of Columbia had legalized or decriminalized marijuana, and four states plus D.C. have gone on to approve it for recreational use, according to the National Organization for the Reform of Marijuana Laws (NORML). So it’s not a stretch to say that it’s likely only a matter of time until other states follow suit. A 2013 Gallup poll showed that 58% of Americans support legalization — a nearly five-fold increase since the research company first asked the question, “Do you think pot should be made legal, or not?” back in 1969.

The multimillion-dollar-question, of course, is: What will the repercussions be, as more states allow pot to be used in much the same way as alcohol? Will there be more abuse? Less? Will addiction rates skyrocket, especially among young people? Or will they remain or level off to much the same as they are now?

These are the questions Addiction.com asked two major players in the field of addiction treatment: David Sack, MD, a board-certified physician in psychiatry, addiction psychiatry and addiction medicine, and CEO of Elements Behavioral Health, and Stanton Peele, PhD, JD, author of Love and Addiction and, most recently, Recover! Stop Thinking Like an Addict with The PERFECT Program. Here’s what Drs. Sack and Peele had to say about whether they believe that expanded access to marijuana will or will not mean greater abuse and rates of addiction:

Dr. David Sack: “It’s not an accident that alcohol is the most widely abused drug; it’s also the most available by virtue of being legal. In just about every drug epidemic, a period of increased access has been followed by increased abuse … Right now, we’re in the middle of an opioid epidemic and the door to the epidemic was really opened by a widespread change and prescribing practices by doctors who had been re-educated to treat pain more aggressively. Starting in the 1980s and 1990s, there was a widespread recognition in the medical community that pain was not adequately treated and doctors were encouraged to use opioid medication more liberally. The net result was that they became more available, so now every family had a bottle of Vicodin or Percocet in the cabinet.

At the beginning of every [drug] epidemic there is a collective denial about how addicting the drug is — we saw it in the 1980s when people were disputing whether cocaine was addictive because the physical withdrawal wasn’t as severe as it was with heroin or opioids. Marijuana advocates want the public to believe that marijuana and cannabinoids [the psychoactive ingredient in marijuana] are not addictive, but all the evidence shows that they are addictive … [and] there is a very high failure rate in treatment [for marijuana addiction]. Most drugs of abuse only last a short while; they get into the nervous system, kick in for a few hours and then they are excreted or inactivated by the liver. Cannabinoids hang around for a very long time and regular smokers store cannabinoids in their fat tissues; they can be excreting them for a month … so we can expect the person who smokes pot regularly to have panic, lack of motivation and concentration at times when they don’t perceive they’re high.

[When considering the consequences of legalizing marijuana] on one hand, you have societal issues: Do you want to ban drugs and restrict drugs as a way of controlling use because it’s safer for the population? Or do you want to legalize them so you don’t make criminals out of citizens and [make] thugs and gangs rich? From a mental health and substance abuse treatment level, the evidence and history of drug use is very clear: We’re going to see more addicts [to marijuana] and more widespread use, and typically the levels of funding necessary to appropriately treat and support this have never been high, so we’re going to wind up with a gap in services.”

Dr. Stanton Peele: “Even I couldn’t say exactly [that] if you legalize pot, it will become more widespread — or what exactly will be the consequence … I look at it that the social context, more than anything else, determines the behaviors. So when you bring underground behavior above ground — that is, making something legal that was illegal — it offers the possibility of regulating it and particularly not even by law but by social regulations … As a backdrop, they did a study at the University at Buffalo Research Institute on Addictions (RIA) and now that gambling is legalized pretty well across the country, they haven’t noticed an upsurge in compulsive gambling.

In Colorado, where they have an upscale marijuana trade, and also in California, where in 2010 they decriminalized marijuana, the results are startlingly positive. In Colorado, they have these very boutique-like marijuana stores and you get an upper middle class clientele that is very good at regulating themselves. If you have a high-standard quality of delivering the products and a clientele that’s upscale, you set up social standards and patterns that you’re going to have pretty good control of your use. I can’t emphasize enough, that in general, upper middle class people in America have learned to be pretty good at delaying gratification and controlling themselves. The same is true with marijuana. Poor people are penalized more legally for use of marijuana, which is totally unfair, however, in general when doctors and New York Times editors and people like that smoke marijuana they are going to tend to regulate their use because they have more to lose if they don’t.

In California, it was even a more interesting experiment … they found a decline in marijuana arrests but also a decline in all arrests for youthful offenders. In 2014, California reduced possession of every drug — heroine, cocaine and meth — to misdemeanors, and they’ve also done this in Portugal. Some people are like, ‘we’re going to have a million heroin addicts,’ but instead people who take the drug may use it in a more normally socially acceptable way: keep a job and try to lead a normal life. The best antidote to addiction is to lead a normal life.

One reason why we do so poorly with addiction and substance abuse is that we don’t give people enough stakes in life and in the community. The best overall answer is to have a social policy that gives people the greatest connection to life. If you give someone a life — if they have a residence and a chance to make meals and get their family better — that’s better treatment than treatment.”

What will greater, easier access to marijuana mean for young people specifically?

Dr. Sack: “The biggest challenge right now is that the way in which pot is being sold — whether medical marijuana or, now, recreational marijuana — is changing dramatically. So the fastest-growing segment, for instance, is edibles. Clearly, these edibles appeal to a younger audience and there’s real reason to be concerned. Although the statutes are written for adults ages 18 and above, the controls to limit that access will be lacking, much in the way that it was for alcohol for many years and for cigarettes. The effects of cannabinoids on the developing brain are very piercing. If you look at the human cortical development, it continues into the mid-20s and what you see is that adolescents who start smoking at a younger age have memory problems, school failure, other psychiatric disorders and are at a significantly greater risk of developing schizophrenia. So we’re not only going to see more kids presenting [to a health care provider] with substance abuse, but with complex psychiatric histories that may be preceded by substance abuse. This becomes a challenge for traditional drug and alcohol treatment centers that may not have psychiatrists or licensed therapists fully integrated into their programs.

Drugs like marijuana seem to be preferentially attractive to adolescents and young adults, so when they see adults smoking pot, they see it as a normal behavior. I think they are going to feel encouraged and less deterred from using. In other words, you can sort of see the stoned parent trying to have a conversation with his/her kid, saying, ‘you’re too young to get stoned,’ and the kid thinking, I’ll just light up two blocks from home.

We are already seeing more young adults coming in [for treatment] who clearly have cannabis dependency as part of their primary problem and I think we’re going to continue to see this increase. There are also a lot more poly-drug [using more than one drug] users than there were in the past. In these cases, detox is more complicated and poly-drug users are harder to treat and harder to keep motivated and engaged in treatment. We have to brace ourselves with better prevention.”

Dr. Peele: “The social regulation of how something is used, the message of use and how you think about yourself using are really critical elements. If you’re not sneaking around doing something — getting back to the youths in California — well, then all of sudden you’re a solid citizen and maybe you can get a better job and maybe you don’t want to get involved in petty crimes because you’re not a criminal and you’re not even ‘bad.’ It’s like sex; most people today try to teach their children that sex isn’t bad and one reason to do that is because people generally tend to have sex. And people generally tend to get intoxicated, one way or another. If you look at the history of the world, it has been going on for quite a long time. Instead of saying, ‘Oh my God, let’s stamp it out, and why would you want to do that?’, it’s harder to say, ‘We know you are going to [smoke pot], but we expect you to behave when you do this.’ When you believe you deserve not to be addicted — and have the right and ability to control your life and have good things — that’s when people are most likely to overcome addiction.

Everyone is going to drink alcohol, more or less, and everyone is going to have a painkiller. If your whole shtick is, ‘My kid will never drink or take drugs,’ you really need a back-up plan, and the back-up plan is how to prevent a person from going overboard.”

What do you think: Will greater access to marijuana lead to more abuse and addiction, or not?

3 Responses to The Addiction.com Debate: Does Legalizing Marijuana Lead to More Addiction?

What a fascinating conversation and question. I think parents and communities have a lot of influence over the outcomes here. If we sit back on our haunches and choose not to influence outcomes – then perhaps more costs will be associated with marijuana legalization.

For those that do engage on a community and family level – well, there are many benefits to occur, starting with an honest conversation.

good and the lovely emotional state of feeling good …or goodness…….i would wish to live in an environment in which this is societally and politically supported……
pharmaceutically and chemically and medicinally and legally ..i am mixed up, it is interesting and inspiring to experience these streams at their source as they flow on down to the ocean.

This is interesting. There is a vulnerability to addiction in my family. I don’t mean, specifically, alcohol or drugs or food or gambling or god or painkillers. I mean any and everything. I am not necessarily addicted to anything, but not without a lot of near misses along the way. This has led me to be very clear with my son. I make him open his eyes and look around, not for a moment but over time — an informal longevity study if you will. So my son, all by himself, has come to his own conclusion: He refuses to use drugs or drink.

I have advised him that he may, and that people do so because they think it makes them feel good, and he may too. He acknowledged that, yes, he may have a couple of beers when he’s older, but he knows he would be selling himself short by believing for a minute that regular use would have no effect on him. My son is “no different than anyone else,” and “Everyone can become an addict.”

He is correct. I am a magnet for substance abusers. I know them across a crowded room. They are not shy in telling me about themselves. I know many, many people who have no dramatic family history of addiction, no beatings or sexual abuse or any other trauma hidden away in the recesses of their minds, no significant mental illness. They were bored, and it seemed like a good idea at the time, so they continued to get drunk and/or high. (Good luck trying to unwind the substances any abuser uses; most of the substance abusers I know use more than one or two but aggressively pursue one preferred, or alpha, high.) Are these people addicts? Don’t know. Socially, there is simply no objective way assess strangers on the street and conclude, “Yep, [s/he’s] an addict, it’s clear.” If a person believes s/he is not an addict, the only conclusion I can make for my own self-preservation is this: “loser. Walk away.” That’s how it works, whether or not the addict admits to a problem.

The reality of any addictive behavior we enjoy is whether we can recognize our own self-inflicted damage before there is a problem. Iin this case, by pot?

Herein lies an immediate and undeniable tension. Do we parent society or do we parent our children and others close to us? Upper middle-classes may be able to cage the wild beast addiction. That does not mean they are not addicts. Anyone who has met a person who quit drinking without support knows how long an addict whose underlying behavior never changes can go before falling off the wagon again, with increasingly detrimental impacts to his or her life — professional, personal, social, practical, and intellectual.

I have never modeled any behavior that an addict has been willing to imitate. Those relationships usually end on some fundamental level, thus disenfranchising the addict whether or not the substance or behavior of abuse is legal. Whether the modelled behavior is declining the last half a drink or saying no to one more shot; refusing to go into a bad neighborhood to pick up a bag of drugs, or simply deciding to get ready for work the next day rather than go out for a quick “happy” hour, I have watched friends kill themselves anyway. I’m watching one kill herself now, and I am helpless to stop it.

I have been suspected and bluntly accused of being judgmental, self-righteous, antisocial, boring. The fact is, I simply cannot remain in a position of perpetual helplessness, and I don’t like watching friends kill themselves. Frankly, even if I take my “selfish” need to protect myself from witnessing another tragedy, I do not have time or energy or desire to babysit another adult who has created the other immediate tension I have noticed: “If she’s my friend, she’ll accept my behavior without judging me,” (read: “she’ll enable me to do whatever I want”), “or she’ll relax…lighten up! and join me for a cocktail.” The flaw in the reasoning is that I want to do nothing get my mourning for this person who has signed a commitment to destroy herself out of my system.

Which brings me back to pot. While, from time to time, I may sit with my friend as she boozes the night away — usually, only to clue her in that her son is being harmed by decisions resulting from her drinking, including tunnel vision about setting her son up to be her caretaker — I am not drinking myself. I may get a whiff of a drunk patron who just hurled whiskey onto the floor, but I get to leave sober, period.

There are problems with pot that go well beyond live and let live. With marijuana, I have to deal with the ‘hotbox.” I do not want to be in a room exposed to marijuana, the only way I can socialize being to possibly get high involuntarily against my will.

Pot is not the same as alcohol, and it should not be lumped together with alcohol the way an endocrinologist lumps Clark Bars versus Butterfingers together in the category of Sugar. Thus, I am immediately separated from any person who uses pot, even recreationally, by this well-known fact. Same goes with a pot smoker’s home, car, office, bathroom, or anywhere else.

I also don’t want a pot smoker’s poor decision- making to lead him or her to feed me a pot cookie or THC pudding, secretly believing I will just love getting high on pot if I only I would give it a shot, just try it — which is exactly what happened to me. Did I get high and “love it”?

You tell me: I suffered — suffered — paranoid delusions, nearly beat someone who said something innocuous, and felt suicidal for several days wondering what would have happened had my son been with me; would I have beaten him? Was my mental health, and by extension, the life of another person, involuntarily endangered, because an idiot wanted me to appreciate the marijuana high? Yes. Do marijuana laws protect me, a non-user?

Just being in the same room with pot smokers, even if I don’t get high, I risk failing random drug testing. I could lose my job whether or not pot is legal because secondhand pot smoke does show up in urine. Why should I lose my job because someone else decided to get high in the same room? Do marijuana laws protect me, as a non-user?

The stakes related to legal pot are higher (pun intended) and more numerous than those related to alcohol because pot has not been legal long enough to study, so no one can refer to any authority other than those that are partisan. Once the car keys are secured, alcohol primarily impacts only the drinker and any family members who live in the same house.

A surprising number of pot smokers also drive while they’re high. I am now talking about what I know from real life, and I am somewhat ignorant about the technical details of paraphernalia.

But there’s something called a “one hitter” (?) a straight metal bowl that looks like a cigarette. Every pot smoker I know keeps one in the car, one in his pocket or her purse, and one in the upstairs bathroom or kitchen. These are the ones who smoke an ounce or more per week. The only regular moderate users I know who are capable of working a standard schedule whip out their one-hitter as soon as they get into their cars. They are unwinding on the commute home. So how do I know this? Carpooling disclosures. No, thank you. You might as well keep a bottle of Jack Daniels under your seat.

Only some of the problems relate to the impacts on bystanders.

The above problems to which I have referred go back to the admonition I gave my 17-year-old son. People do it because they think it makes them feel good. I did not like it. The next person with a predisposition to addiction j (maybe, God forbid, my son) might love it.

The number of high school kids smoking pot is crazy; this is the time when many regular pot smokers started smoking, and the damage is not easily undonel. Combine a teenager’s invincibility, a need to fit in, and sudden social acceptance of a drug that fries teenage brains, and you’ve got our next generation. Regardless of what happened in California, prescriptions are legal too, and that doesn’t stop a kid who’s bored. California’s general laws related to low-level drug offenders and treatment have changed the playing field from goal post to goal post.

The most telling annoying attitudes in this unfolding saga are those of pot smokers who believe cigarette smoking is much worse than pot and marijuana has no health impacts on the lungs. Which is ridiculous. This flies in the face of even mediocre reasoning.

This argument seems to be, even if smoking pot might cause cancer, only heavy users will get cancer/ bronchitis/ emphysema/ COPD. By this flawed logic, occasional tobacco smokers should be left alone because only heavy tobacco smokers are going to get sick. What? Pot increases the risk of lung cancer by about ten percent; cigarettes, 20 percent. And where are my cigarettes, and where is the lobby to get the government and those annoying as campaigns out of my face?

Should pot be legalized or decriminalized nationwide? Sure. But only if the one-size-fits-all mentality about the unique benefits and consequences of pot, as well as overturning rampant denials of accurate information that may not bolster the position of pro- or anti-legalization lobbies, are thought through in the preparation stages rather than after there is an unforeseen crisis. This goes for ensuring there are abundant resources to address those addicts who do not believe they are addicts, who then cannot legally be treated without court orders, are carefully and aggressively put into play. We won’t need quite as hefty a prison budget. And I haven’t seen it yet. There are people in my office who cannot get through the day without taking a hit of pot in the copy room and fouling the air. But cigarettes kill.